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Singapore is a country with moderate risks of stomach cancer. It is the seventh most common cancer in men and the ninth most common cancer in women in the Singapore population. According to Singapore Cancer Registry’s 50th Anniversary Monograph (1968-2017), the subgroup of Chinese males have the highest risk of developing stomach cancer compared to the Malays and Indians for both genders. Between 2008 and 2012, the age-standardised incidence rate for stomach cancer in Singaporean Chinese males is 13.4 in 100,000. 

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Causes of stomach cancer

It is believed that the occurrence of stomach cancer is related to: 

• Helicobacter pylori infection is the most significant cause of stomach cancer. pylori is a spiral-shaped organism that burrows into the mucus found lining the stomach. This can cause peptic ulcers, and it can also trigger a transformation in the stomach that leads to cancer change.
• Family history of gastric cancer, or related malignancies such as colon and breast cancers.
• Consumption of salted, preserved and pickled foods have been proven to increase one’s risk of developing stomach cancer. Salt damages the stomach lining and causes lesions, which can deteriorate and become stomach cancer.
• Smoking. Tobacco use increases stomach cancer risk, particularly for cancers of the upper part of the stomach near the oesophagus.

Symptoms

In the early stages, gastric cancer may be asymptomatic. It may cause very subtle symptoms such as bloating or indigestion. As such, it usually presents late. The usual symptoms of advanced gastric cancer are: 

• Pain and discomfort in the upper abdomen
• Early satiety (fullness after a small meal)
• Vomiting, loss of weight and loss of appetite
• Occasionally, it presents as an emergency with severe pain or bleeding (vomiting of blood or passage of black stools due to altered blood)

Generally, the treatment of late-stage stomach cancer has poor outcomes. 

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Early investigation

Unlike Japan and South Korea, Singapore does not have a national endoscopic screening programme to detect stomach cancer early. However, if you have suffered a recent onset of “gastric pain” or any of the symptoms mentioned above, and have not been investigated before, you should see your family doctor to see if a gastroscopy is recommended. This is a simple, 10-minute test in which a thin, flexible telescope is inserted through the mouth and into the stomach for a complete visualisation of the cause of your symptoms. 

This article has been verified medically by Dr Melvin Look, consultant surgeon at Surgi-TEN Specialists, Farrer Park Hospital (Singapore).

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